Updated 31 July 2014

Tim Noakes called a 'cholesterol denialist'

A team of top doctors has warned that the Tim Noakes diet could be dangerous, especially for heart patients.

A team of top doctors has warned that Tim Noakes had gone "too far in suggesting that a switch to a high-fat, high-protein diet is advisable for all persons" and that it could be dangerous for patients with coronary heart disease or persons who are at risk of coronary heart disease.

In a letter to the Cape Times on Friday, six Cape Town doctors expressed their concern that a number of patients had been placing their health at risk "by discontinuing statin therapy (cholesterol-lowering agents) and their prudent diets on the basis of this 'expert opinion'".

The six signatories of the letter were Patrick Commerford (professor of cardiology and head of the cardiac clinic at UCT and Groote Schuur Hospital), Miko Tshekhe (of the cardiac clinic at UCT and Groote Schuur Hospital), Dirk Blom (of the lipid clinic department of medicine at UCT and Groote Schuur Hospital), David Marais (of chemical pathology and clinical laboratory services at UCT’s Health Science Faculty), and cardiologists Elwyn Lloyd and Adrian Horak.

"Having survived 'Aids Denialism' we do not need to be exposed to 'Cholesterol Denialism'," they warned.

Prof Noakes's response

In a response to the doctors' letter Prof Tim Noakes wrote the following to Health24:

"I will be responding to the doctors' letter and am glad that we can now take the debate into the public space. That is what the public deserves. I have never said that the diet is for everyone (although it might be) and clearly state in 'Challenging Beliefs' and on your website that this eating plan is ideal for those like me who have carbohydrate intolerance. Let the real debate begin..."

In his book Challenging Beliefs, Professor Tim Noakes (a professor of exercise and sports science and head of the Sports Science Institute of SA) challenges conventional dietary guidelines of a balanced diet low in fat with all food groups represented and carbohydrates forming the basis. Instead he recommends a diet high in protein and fats. He also claims that not all saturated fats are bad; that cholesterol is not the unique cause of heart disease; and that taking statins may be unnecessary.

"There is no definitive evidence that reducing especially the saturated fat in the diet prevents heart disease,” Noakes comments in his book. “The theory that proposes that blood cholesterol causes heart disease is at best tenuous, and at worst wrong."

Noakes turned to this new diet when he discovered that he was "pre-diabetic" (also called carbohydrate resistant in some circles). This means that the cells in his body were becoming insulin resistant and struggling to break down the glucose in his body (carbohydrates are known to spike glucose levels). People with pre-diabetic symptoms are at high risk of developing type 2 diabetes.

Since removing most carbs from his diet (his only sources of carbs are a limited selection of veggies and dairy; he avoids grains and cereals altogether), Noakes has reportedly seen a great improvement in his health. "I am at my lightest weight in 20 years and I am running faster than I have in 20 years," he wrote in an article for Discovery Magazine.

High fat and cholesterol

Though the team of doctors agree with his views on carbs and obesity, they strongly disagree with his views on cholesterol and the benefits of high-protein, high-fat diets.

"Such a diet may have allowed him to lose weight and run faster but its widespread implementation is contrary to the recommendations of all major cardiovascular societies worldwide, is of unproved benefit and may be dangerous for patients with coronary heart disease or persons at risk of coronary heart disease.

"Further his questioning of the value of cholesterol-lowering agents (statins) is at best unwise and may be harmful to many patients on appropriate treatment. The very strong evidence is that statins in patients with coronary artery disease improve mortality (they make you live longer). Multiple placebo-controlled studies have confirmed this."

They add that generic statins are now cheap and should be widely used. The side-effect profile of these agents is benign and there is general agreement that their benefits far outweigh any minor risks associated with their use.

"Noakes is welcome to his views," the team concludes, however "to present these controversial opinions as fact to a lay public, in his unrefereed book, is dangerous and potentially very harmful to good patient care," they heed. "Scientists and clinicians have an ethical obligation to ensure that the information they impart to their patients and the public at large is correct, in line with best available evidence, and will not cause harm."

- (Health24, September 2012)

* The Sport Science Institute has release a Healthy Diet 2012 Joint Statement drawn up by a range of experts from UCT’s ESSM (Exercise Science and Sports Medicine unit) and other consulting academics. It reflects where SSISA stands on the matter and was compiled in response to the nutritional debate raging in the media. Read the Healthy Diet 2012 Joint Statement on Health24. The statement is also available on the Sport Science Institute (SSISA) website.

What are your thoughts on this debate? Send your comments to community@health24.comwith "Tim Noakes" in the topic line.

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